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2015 HSR&D/QUERI National Conference Abstract

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3057 — Using a Secure SharePoint Provider Reminder System Improves Rates of Inferior Vena Cava Filter Retrieval

Mobarek DA, Washington, DC VAMC, George Washington University,Georgetown University,Washington, DC; Bade N, Washington, DC VAMC, George Washington University,Georgetown University,Washington, DC; Elamm J, Washington, DC VAMC, George Washington University,Georgetown University,Washington, DC; Aggarwal A, Washington, DC VAMC, George Washington University,Georgetown University,Washington, DC; Tabar S, Washington, DC VAMC; Bentt D, Washington, DC VAMC; Faselis C, Washington, DC VAMC, George Washington University,Georgetown University,Washington, DC; Rickles F, Washington, DC VAMC, George Washington University,Georgetown University,Washington, DC;

Objectives:
Inferior vena cava (IVC) filter placement has increased significantly over recent years. IVC filters have been shown to offer short term protection against pulmonary embolism (limited to weeks) and furthermore, have been implicated in increased complication rates in the long term. A U.S. FDA safety communication (2010 and 2014) states that IVC filters should be removed to reduce complications, including an increased incidence of DVT, filter migration, filter embolization, filter fracture, and IVC perforation. IVC filter retrieval rate is dismal nationally. We performed a local VISN as well as a national review, and found that only 7%-12% of retrievable IVC filters placed over an eight-year period were actually removed.

Methods:
To comply with FDA recommendation, a prospective study evaluating the utility of tracking filters in a secure system was performed. Patients with IVC filters inserted by interventional radiology (IR) were entered into a secure SharePoint database. An automated email is sent to a hematologist two months after placement alerting the recipient to assess the patient record. The evaluating physician enters a decision of whether the filter should be retrieved, kept indefinitely, or delayed.

Results:
Thirty six patients with IVC filters were tracked from April 2013 through February 2015. Hematology recommendations were to retrieve 12 filters, delay decision in 14 cases, and keep indefinitely in 10 patients. Eleven IVC filters were retrieved without complication and one is scheduled for retrieval. Within the delay decision group, 3 were recommended for retrieval (of which 2 have been retrieved), 2 to keep indefinitely, and 4 to further delay decision.

Implications:
In this pilot study, over the past 23 months, our tracking tool and multidisciplinary communications platform have improved retrieval rates from 7% to 87%. While we recognize this data is preliminary, we anticipate continued quality improvement using this system both locally and nationally with the ongoing replication at other VA medical centers.

Impacts:
There has been a significant increase in tracking and appropriate removal of retrievable IVC filters thus complying with the FDA recommendation and possible complication reduction from inappropriately retained filters. This is a structured method for improvement in the health care of our veterans